The Prevalence of Vagal Nerve Stimulator-induced Sleep Disordered Breathing in Children With Refractory Epilepsy: A Retrospective Cohort Study
Bibliographic record
Abstract
Abstract Rationale: Vagal nerve stimulators (VNS) are effective in achieving seizure control in children with refractory epilepsy. Recently, VNS devices in children have been associated with sleep-disordered breathing (SDB) including obstructive sleep apnea (OSA) and central sleep apnea (CSA). However, the direct impact of VNS on sleep parameters by formal polysomnography (PSG) is not well studied. Our objective was to assess the prevalence of SDB in children with epilepsy using PSG before and after VNS implantation. Methods: A retrospective cohort study was conducted (May 2019 to September 2024) of children aged 0 to 18 years old with refractory epilepsy and VNS insertion at The Hospital for Sick Children, Toronto, Canada. All included children underwent level 1 baseline PSG evaluation within 1 year prior to VNS insertion. Once VNS was inserted, a repeat PSG was conducted within 6 months. Paired t-tests and Wilcoxon-matched-pairs tests compared respiratory variables from PSGs before and after VNS insertion. Results: A total of 27 children with a mean (SD) age of 8.8 (4.2) years were included. Prior to PSG insertion, 5 (19%) children had mild OSA, 1 (4%) had moderate OSA, 0 (0%) had severe OSA, 2 (7%) had CSA, and 1 (4%) had nocturnal hypoventilation. Following VNS insertion, 8 (30%) had mild OSA, 1 (4%) had moderate OSA, 2 (7%) had severe OSA, and none had CSA or nocturnal hypoventilation. Amongst PSG parameters, there was a significant increase in the mean (SD) obstructive apnea-hypopnea index (OAHI) from 1.6 (3.2)/hour to 6.3 (13.8)/hour (p=0.005) after VNS insertion. The OAHI in REM sleep also increased significantly from 5.7 (9.6)/h to 7.6 (13.3)/h (p=0.03). Eight of the 9 (89%) children who developed OSA after VNS had baseline symptoms of SDB even prior to VNS insertion. The remaining PSG values did not differ significantly before and after VNS implantation (Table 1). Conclusions: The severity of OSA may increase in children with epilepsy treated with VNS. Children with pre-existing symptoms of SDB are at highest risk of developing OSA after VNS insertion. All children being planned for VNS should be routinely screened for symptoms of SDB.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".